Survey of ophthalmology最新文献

A 54-year-old woman with myopia, hypothyroidism, and asthma presented with intermittent double vision. Serum was positive for anti-low density lipoprotein receptor-related protein 4 (LRP4) antibodies suggesting the diagnosis of myasthenia gravis. There was no improvement with pyridostigmine, prednisone, or azathioprine. Over time her double vision became constant, and she was noted to have mild limitation of abduction in both eyes with an esotropia, left hypotropia, and excyclotorsion. Magnetic resonance imaging showed nasal displacement of the superior rectus and inferior rectus muscles, inferior displacement of the lateral rectus muscles and superotemporal globe prolapse consistent with heavy eye syndrome (HES). The differential diagnosis, clinical and radiological manifestations of HES are discussed.

Keratoconus is a common pediatric corneal disease, leading to vision impairment and amblyopia. Compared to its adult counterpart, pediatric keratoconus has an advanced presentation, rapid progression, higher incidence of complications such as corneal hydrops, and greater potential impact on the quality of life. It typically manifests during puberty and can evolve rapidly to more severe stages if left untreated. This rapid progression underscores the importance of early diagnosis through regular screening in pediatric populations and vigilant monitoring of pediatric keratoconus suspects. Concomitant ocular allergies, ocular anomalies, systemic diseases (e.g. syndromes), and poor compliance with contact lenses might impede prompt intervention and frequently postpone rehabilitation. Corneal collagen crosslinking is a crucial intervention in the management of pediatric keratoconus because it strengthens the corneal microstructure and halts the disease progression. When conservative measures fail, keratoplasty remains a viable option with generally favorable outcomes, though with unique challenges in post-operative care, including concerns related to sutures, long-term graft survival and need for repeated examinations under anesthesia. A multidisciplinary approach involving ophthalmologists, optometrists, pediatricians, and other healthcare professionals, focusing on early diagnosis and timely intervention, is essential for the comprehensive management of pediatric keratoconus and to mitigate its impact on children's lives.

Artificial intelligence(AI)-based methods have been extensively used for the detection and management of various common retinal conditions, but their targeted development for inherited retinal diseases (IRD) is still nascent. In the context of limited availability of retinal subspecialists, genetic testing and genetic counseling, there is a high need for accurate and accessible diagnostic methods. The currently available AI studies, aiming for detection, classification, and prediction of IRD, remain mainly retrospective and include relatively limited numbers of patients due to their scarcity. We summarize the latest findings and clinical implications of machine-learning algorithms in IRD, highlighting the achievements and challenges of AI to assist ophthalmologists in their clinical practice.

Vitreous floaters are visual phenomena resulting from floating opacities inside the eye that disturb vision. The opacities consist of microscopic collagen fibers that aggregate in myopia and during aging. These collagen fibers are then seen as irregular, sometimes worm-like shadows or structures of a translucent to black color. Because of the floating aspect, they tend to follow the movements of the eye, causing distress and having a negative impact on a patient's quality of life due to degradation in contrast sensitivity function. This is referred to as vision degrading myodesopsia (VDM). The overall importance of floaters and their effect on quality of life gained attention in recent years. While the existence of floaters alone is labeled as harmless, there is an increasing group of young people suffering from VDM. This coincides with the growing prevalence of myopia. Indeed, myopia and myopic vitreopathy are the major causes of VDM in the young. This aspect of myopia, however, is often overlooked. We review the current research status in floater formation, quality of life impact, symptom assessment, localization and therapeutic options for vitreous floaters from the perspective of a myopic, potentially younger patient group.

People with multiple sclerosis (pwMS) encounter numerous ocular complications, including uveitis. MS-related uveitis is linked to diverse complications, encompassing cataracts, cystoid macular edema, band keratopathy, glaucoma, retinal detachment, retinoschisis, vitreous hemorrhage, and occlusive vasculitis. The relationship between uveitis and MS is firmly established, but various prevalence rates have been reported. Hence, we aimed to determine the overall prevalence of uveitis and its different types among pwMS. The systematic search was conducted across PubMed/MEDLINE, Scopus, EMBASE, and Web of Science to identify studies published between January 1, 1990, and November 11, 2023. The meta-analysis was performed using R software version 4.3.3 with a random-effect model to calculate the pooled prevalence with a 95 % confidence interval (CI) of uveitis among pwMS. From a total of 2520 studies reviewed, 12 studies met the inclusion criteria, comprising a total of 54,402 pwMS. Of whom, 72 % were female, and the mean (standard deviation) age was 43.5 (12.1) years. Meta-analysis showed that the pooled prevalence of uveitis among pwMS was 1.1 % (95 % CI: 0.6-1.7 %, I²=95 %, p-heterogeneity<0.01). Moreover, among various uveitis types, intermediate uveitis exhibited the highest prevalence of 0.6 % (95 % CI: 0.2-1.0 %, I² = 87 %, p-heterogeneity < 0.01) in pwMS. We determined that the prevalence of uveitis among pwMS is 1.1 %. Among different uveitis types, intermediate uveitis stands out as the most prevalent in pwMS. Diagnosing uveitis in pwMS within clinics by specialists is imperative.

Our aim was to assess the visual outcomes of patients with Leber hereditary optic neuropathy (LHON) harboring the m.11778G>A MT-ND4 mutation who had no treatment (natural history) or received idebenone or lenadogene nolparvovec. Efficacy outcomes included clinically relevant recovery (CRR) from nadir and final best-corrected visual acuity (BCVA). For the natural history and idebenone groups, we performed a systematic review of the literature and available clinical/regulatory reports. For the lenadogene nolparvovec group, all data from phase 3 studies were included. The overall effect and its 95 % confidence interval (CI) were estimated using a random effects model. For each meta-analysis, patients had a mean age of approximately 30 years at vision loss and were mostly (≥78 %) men. The CRR from nadir [95 % CI] at eye level was 17 % [7 %; 30 %] (n=316 eyes), 31 % [24 %; 40 %] (n=313) and 59 % [54 %; 64 %] (n=348) in untreated, idebenone-treated and lenadogene nolparvovec-treated patients, respectively. This gradient of efficacy was also observed with CRR at the patient level and final BCVA. There was a gradient of efficacy in all assessed visual outcomes, more marked for CRR than for final BCVA, with lenadogene nolparvovec gene therapy superior to idebenone treatment, and both superior to the natural history of the disease.

Multifocal functional tests are not routinely performed in diabetic retinopathy (DR) and diabetic macular edema (DME) management. We emphasise their importance and coin the term functional diabetic retinopathy (FDR). We reviewed current guidelines on management of DR/DME, and literature on diabetic retinal neurodegeneration (DRN) and functional deficits in DR/DME. Functional visual loss due to DRN precedes vasculopathy and clinical DR; however, currently the diagnosis and management of DR/DME are based on classical signs of retinal vasculopathy and structural changes shown by funduscopy, fundus photographs, and optical coherence tomography (OCT). Furthermore, DME can mask DRN-based retinal layer thinning by OCT and is focussed on the macular region. The only functional test recommended in national and international guidelines on DR/DME is best-corrected visual acuity, a test of foveal function (<1 % of retina). Multifocal functional tests can objectively characterize both foveal and extrafoveal, localized and global, function. Current recommendations for DR/DME screening are inadequate to detect FDR affecting the greater retina. Early detection of FDR using multifocal functional tests could bring DR/DME management strategies forward enabling prevention of the later stage vision-threatening complications. After all, the end point of patient care is functional outcomes.

Cytomegalovirus retinitis (CMVR) is a significant cause of blindness in patients with advanced acquired immunodeficiency syndrome (AIDS). There are no established guidelines for its treatment, resulting in varied antiviral approaches. We pooled data from 59 studies (4501 patients) to evaluate treatment variations and outcomes (CRD42022321088). Overall pooled estimates showed visual acuity improvement at 18 % (95 % CI: 7-41 %), inflammation resolution at 90 % (95 % CI: 81-95 %), retinal detachment at 11 % (95 % CI: 8-14 %), and recurrence at 19 % (95 % CI: 11-31 %). The main antiviral treatment approaches identified were: (1) intravenous antivirals alone in 33 studies, (2) intravitreal antivirals alone in 26 studies, (3) oral antivirals alone in 3 studies, and (4) a combination of systemic (oral or intravenous[IV]) and intravitreal antivirals in 7 studies, with varying schemes and durations. Ganciclovir was the predominant antiviral, with intravenous administration being the most reported (in 23 studies), followed by intravitreal administration (in 20 studies). While visual acuity improvement was comparable, inflammation resolution tended to be higher with intravitreal than with IV antivirals, though not statistically significant (88 %, 95 % CI: 69-96 % vs 75 %, 95 % CI: 35-94 %, p = 0.38). Retinitis progression rate for IV ganciclovir was lower than for those without ganciclovir. Inflammation recurrence was significantly lower in antiretroviral (ART)-treated compared to non-ART-treated HIV/AIDS patients (10 % (95 % CI: 4-20 %) vs 33 % (95 % CI: 19-50 %), p < 0.01). Neutropenia, particularly with ganciclovir, was the most reported adverse effect (up to 50 %).

Vital dyes are used to help visualize the retinal surface during macular surgery; however, they have been associated with phototoxicity. We synthesize and collate post-market surveillance data in two of the most commonly used dyes, Brilliant Blue G and Trypan Blue. We identified 69 cases, 59 of which were from the literature and 10 from manufacturer post-market surveillance. Of 69 vitrectomies, 39 were for macular hole, 24 for epiretinal membrane, 2 for vitreomacular traction, and 4 were not specified. The incidence of dye-mediated phototoxicity is likely rare, but is not possible to quantify, due to potential reporting and publication bias favouring dissemination of unusual safety events, but conversely underreporting is possible. Additionally, phototoxicity was reported prior to the introduction of vital stains, so it can be difficult to establish whether vital staining was contributory. Prolonged surgery and repeat staining were identified as risk factors. Characteristic clinical features were macular pigmentary change with hypo- and hyper-autofluoresence, often sparing the fovea. Final visual acuity tended to be worse than preoperatively, with some cases reduced to counting fingers. A reporting template is provided to encourage complete and standardised toxicity reporting and help build a robust evidence base.

As the prevalence of diabetes mellitus increases each year, its most common microvascular complication, diabetic retinopathy (DR), is also on the rise. DR is now regarded as an inflammatory disease in which innate immunity plays a crucial role, and a large number of innate immune cells with associated cytokines are involved in the pathologic process of DR. The role of adaptive immunity in DR is seldom mentioned, probably due to the general perception of the immune privileged environment of the retina; however, in recent years there has been a gradual increase in research on the role of adaptive immunity in DR, and with the discovery of the retinal lymphatic system, it seems that the role of adaptive immunity can no longer be ignored. Here, we discuss the immunosuppressive environment of the retina, the phenomenon and potential mechanisms of lymphocyte infiltration in DR, and the role of the adaptive immune system in the diabetic retina, which may point the way for future research.